Meaningful Measures

Session 113, February 13, 2019

Michelle Schreiber, M.D., Director of the Quality Measurement and Value-based Incentives

Group, CMS

Reena Duseja, M.D., M.S. Chief Medical Officer, Quality Measurement and Value-Based

Incentives Group, CMS

Michelle Schreiber, M.D.

Reena Duseja, M.D., M.S.

Have no real or apparent conflicts of interest to report.

Conflict of Interest

• Introduction

• Meaningful Measures

– New Approach to Meaningful Outcomes

– Four Strategic Goals

– Objectives

– Framework

– Progress to Date

– Next Steps

– Resources

• Question & Answer Session

Agenda

1. Understand the purposes of the Meaningful Measures initiative

2. Learn about the Meaningful Measures framework and how CMS

uses it to streamline quality measures across its quality reporting

programs

3. Obtain feedback on how to update and improve the Meaningful

Measures framework to focus on measures that matter most to

clinicians and patients

Learning Objectives

• CMS’s Primary Goal: Remove obstacles that get in the way of

the time clinicians spend with their patients

• Patients Over Paperwork

– Shows CMS’s commitment to patient-centered care and

improving beneficiary outcomes

– Includes several major tasks aimed at reducing burden for

clinicians

– Motivates CMS to evaluate its regulations to see what could

be improved

Introduction

What is Meaningful Measures Initiative?

• Launched in 2017, the purpose of the Meaningful Measures

initiative is to:

– Improve outcomes for patients

– Reduce data reporting burden and costs on clinicians and

other health care providers

– Focus CMS’s quality measurement and improvement efforts

to better align with what is most meaningful to patients

A New Approach to Meaningful Outcomes

Why Implement the Meaningful Measures Initiative?

• There are too many measures and disparate measures

• Administrative burden of reporting

• Lack of simplified ways to focus on critical areas that matter most

for clinicians and patients

• Promote alignment across continuum and across payers

• Promote innovation in new types of measures

A New Approach to Meaningful Outcomes

Empower patients

and doctors to make

decisions about their

health care

Support innovative

approaches to improve

quality, accessibility,

and affordability

Usher in a new era

of state flexibility

and local leadership

Improve the CMS

customer

experience

Meaningful

Measures: Guided

by Four Strategic

Goals

Meaningful Measures focus on everyone’s efforts on the same quality

areas and lend specificity, which can help identify measures that:

Meaningful Measures Objectives

Address high-impact

measure areas that

safeguard public

health

Are patient-centered

and meaningful to

patients, clinicians and

providers

Are outcome-based

where possible

Fulfill requirements

in programs’

statutes

Minimize level of

burden for providers

Identify significant

opportunity for

improvement

Address measure

needs for population

based payment

through alternative

payment models

Align across programs

and/or with other

payers

Meaningful Measure Areas Achieve

• High quality healthcare

• Meaningful outcomes for patients

Meaningful Measures Framework

Criteria meaningful for patients and actionable for providers

Draws on measure work by:

• Health Care Payment Learning

and Action Network

• National Quality Forum- High

Impact Outcomes

• National Academy of Medicine –

IOM Vital signs Core Metrics

Includes perspectives from

experts and external

stakeholders:

• Core Quality Measures

Collaborative

• Agency for Healthcare

Research

and Quality

• Many other external

stakeholders

Quality Measures

KEY LEVERS

Vision for Quality Reporting

 Relevant,

actionable data

is accessible to

a variety of

audiences

 Patients and

caregivers have

access to data

 An enterprise-

wide strategy

for measure

selection

focuses on

patient-

centered,

outcome, and

longitudinal

measures

 Infrastructure

supports

development

of health IT

enabled

measures

 Aligned and

streamlined policies

and processes for

quality reporting and

value based

purchasing programs

 CMS demonstration

programs have

flexibility

to test innovative

models, while

maintaining a desired

end state of

alignment with legacy

CMS programs

 Ongoing, timely

information is

provided to health

care professionals

 Data collection and

exchange is low

burden

 Quality measure data

is fed into planning

and implementation

of quality

improvement

initiatives

 Measures

development begins

from a person-

centered perspective

 Involve patients and

caregivers in measure

development and

public reporting efforts

 Involve first-line health

care professionals on

the front line are

involved in measure

development,

implementation, and

data feedback

processes

Aligned Quality

Reporting and

Value-based

Purchasing

Aligned

Measure

Portfolio

Optimize Public

Reporting

Strengthen/Facilitate

Interoperability

Engage Patients

and Providers

Meaningful Measures

Improve CMS Customer Experience

Support State Flexibility and Local

Leadership Support Innovative

Approaches

Empower Patients

and Doctors

SAFEGUARD

PUBLIC HEALTH

TRACK TO

MEASURABLE

OUTCOMES

& IMPACT

ACHIEVE

COST

SAVINGS

IMPROVE ACCESS

FOR RURAL

COMMUNITIES

REDUCE

BURDEN

EMLIMINATE

DISPARITIES

Promote Effective Communication

& Coordination of Care

Meaningful Measure Areas:

• Medication Management

• Admissions and

Readmissions to Hospitals

• Transfer of Health Information

and Interoperability

Promote Effective Prevention

& Treatment of Chronic Disease

Meaningful Measure Areas:

• Preventive Care

• Management of Chronic Conditions

• Prevention, Treatment, and Management

of Mental Health

• Prevention and Treatment of Opioid and

Substance Use Disorders

• Risk Adjusted Mortality

Work With Communities to Promote

Best Practices of Healthy Living

Meaningful Measure Areas:

• Equity of Care

• Community Engagement

Make Care Affordable

Meaningful Measure Areas:

• Appropriate Use of Healthcare

• Patient-focused Episode

of Care

• Risk Adjusted Total Cost of Care

Make Care Safer by Reducing Harm

Caused in the Delivery of Care

Meaningful Measure Areas:

• Healthcare-Associated Infections

• Preventable Healthcare Harm

Improve CMS Customer Experience

Support State Flexibility and Local

Leadership Support Innovative

Approaches

Empower Patients

and Doctors

SAFEGUARD

PUBLIC HEALTH

TRACK TO

MEASURABLE

OUTCOMES

& IMPACT

ACHIEVE

COST

SAVINGS

IMPROVE ACCESS

FOR RURAL

COMMUNITIES

REDUCE

BURDEN

EMLIMINATE

DISPARITIES

Strengthen Person & Family

Engagement as Partners in their Care

Meaningful Measure Areas:

• Care is Personalized and

Aligned with Patient’s Goals

• End of Life Care according

to Preferences

• Patient’s Experience of Care

• Patient Reported

Functional Outcomes

Improve CMS Customer Experience

Support State Flexibility and Local

Leadership Support Innovative

Approaches

Empower Patients

and Doctors

SAFEGUARD

PUBLIC HEALTH

TRACK TO

MEASURABLE

OUTCOMES

& IMPACT

ACHIEVE

COST

SAVINGS

IMPROVE ACCESS

FOR RURAL

COMMUNITIES

REDUCE

BURDEN

EMLIMINATE

DISPARITIES

Improve CMS Customer Experience

Support State Flexibility and Local

Leadership Support Innovative

Approaches

Empower Patients

and Doctors

SAFEGUARD

PUBLIC HEALTH

TRACK TO

MEASURABLE

OUTCOMES

& IMPACT

ACHIEVE

COST

SAVINGS

IMPROVE ACCESS

FOR RURAL

COMMUNITIES

REDUCE

BURDEN

EMLIMINATE

DISPARITIES

Improve CMS Customer Experience

Support State Flexibility and Local

Leadership Support Innovative

Approaches

Empower Patients

and Doctors

SAFEGUARD

PUBLIC HEALTH

TRACK TO

MEASURABLE

OUTCOMES

& IMPACT

ACHIEVE

COST

SAVINGS

IMPROVE ACCESS

FOR RURAL

COMMUNITIES

REDUCE

BURDEN

EMLIMINATE

DISPARITIES

Improve CMS Customer Experience

Support State Flexibility and Local

Leadership Support Innovative

Approaches

Empower Patients

and Doctors

SAFEGUARD

PUBLIC HEALTH

TRACK TO

MEASURABLE

OUTCOMES

& IMPACT

ACHIEVE

COST

SAVINGS

IMPROVE ACCESS

FOR RURAL

COMMUNITIES

REDUCE

BURDEN

EMLIMINATE

DISPARITIES

Improve CMS Customer Experience

Support State Flexibility and Local

Leadership Support Innovative

Approaches

Empower Patients

and Doctors

SAFEGUARD

PUBLIC HEALTH

TRACK TO

MEASURABLE

OUTCOMES

& IMPACT

ACHIEVE

COST

SAVINGS

IMPROVE ACCESS

FOR RURAL

COMMUNITIES

REDUCE

BURDEN

EMLIMINATE

DISPARITIES

MEANINGFUL MEASURE AREAS:

Promote Effective Communication &

Coordination of Care

MEDICATION MANAGEMENT

Use of High Risk Medications in the

Elderly - QPP

Medication Reconciliation Post-

Discharge - MSSP

Annual Monitoring for Patients on

Persistent Medications (MPM) - QRS

Drug Regimen Review Conducted with

Follow-Up for Identified Issues - IRF

QRP, LTCH QRP, SNF QRP, HH QRP

Measures

Standardized Readmission

Ratio (SRR) - ESRD QIP

Plan All-Cause Readmissions -

Medicaid & CHIP

ADMISSIONS AND

READMISSIONS TO

HOSPITALS

Measures

Use of an Electronic Health

Record - IPFQR, QIO

TRANSFER OF HEALTH

INFORMATION

AND INTEROPERABILITY

Measures

Promote Effective Communication &

Coordination of Care

Programs Using Illustrative Measures

Quality Payment Program

(QPP)

Medicare Shared Savings

Program (MSSP)

Health Insurance Marketplace

Quality Rating System (QRS)

Inpatient Rehabilitation Facility

Quality Reporting Program (IRF

QRP)

Skilled Nursing Facility Quality

Reporting Program (SNF QRP)

Long-Term Care Hospital Quality Reporting

Program (LTCH QRP)

Home Health Quality Reporting Program

(HH QRP)

End-Stage Renal Disease Quality Incentive

Program (ESRD QIP)

Medicaid and CHIP (Medicaid & CHIP)

Inpatient Psychiatric Facility Quality

Reporting (IPFQR) Program

Quality Improvement Organization (QIO)

MEANINGFUL MEASURE AREAS:

Promote Effective Prevention & Treatment of

Chronic Disease

Measures

Follow-up after

Hospitalization for

Mental Illness -

IPFQR

Measures

Alcohol Use

Screening -

IPFQR

Use of Opioids at

High Dosage -

Medicaid & CHIP

Measures

Hospital 30-Day,

All Cause, Risk-

Standardized

Mortality Rate

(RSMR) Following

Heart Failure (HF)

Hospitalization -

HVBP

Measures

Osteoporosis

Management in

Women Who Had a

Fracture - QPP

Hemoglobin A1c

Test

for Pediatric

Patients (eCQM) -

Medicaid & CHIP

Measures

Influenza

Immunization

Received for

Current Flu Season

- HH QRP

Timeliness of

Prenatal Care

(PPC) - Medicaid &

CHIP

Well-Child Visits in

the First

15 Months of Life (6

or More Visits) -

Medicaid & CHIP

RISK

ADJUSTED

MORTALITY

PREVENTION

AND

TREATMENT OF

OPIOID AND

SUBSTANCE

USE

DISORDERS

PREVENTION,

TREATMENT, AND

MANAGEMENT

OF MENTAL

HEALTH

MANAGEMENT

OF CHRONIC

CONDITIONS

PREVENTIVE

CARE

Promote Effective Communication &

Coordination of Care

Programs Using Illustrative Measures

• Quality Payment Program (QPP)

• Home Health Quality Reporting Program (HH QRP)

• Medicaid and CHIP (Medicaid & CHIP)

• Inpatient Psychiatric Facility Quality Reporting (IPFQR)

Program

• Hospital Value-Based Purchasing (HVBP) Program

The Meaningful Measures initiative:

• Aligns with existing quality reporting programs and helps programs to

identify and select individual measures

• Allows clinicians and other health care providers to focus on patients and

improve quality of care in ways that are meaningful to them

• Intends to capture the most impactful and highest priority quality

improvement areas for all clinicians including specialists

• Is used to guide rulemaking, measures under construction lists, and

impact assessments

Getting to Measures that Matter

From Vision to Reality: Progress to Date

CMS is implementing the Meaningful Measures framework

through the following:

• Measures Under Consideration(MUC) List for Medicare quality reporting

and value-based purchasing programs

• Fiscal Year (FY) 2019 Medicare Hospital Inpatient Prospective Payment

System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective

Payment System Proposed Rule

• Quality Payment Program Year 3 Notice of Proposed Rulemaking (NPRM)

• MACRA Funding Opportunity to Develop Measures for Quality Payment

Program

• Merit-based Incentive Payment System (MIPS) Call for Measures and

Activities for 2019 and 2020

Meaningful Measures: Progress to Date

MUC Lists

• Last year, narrowed the initial 184 measures submitted during the open

call for measures to 32 measures (83% reduction); this reduced

stakeholder review efforts

• The 32 measures:

– Focus on achieving high quality health care and meaningful

outcomes for patients, while minimizing burden

– Have the potential to drive improvement in quality across numerous

settings of care, including clinician practices, hospitals, and dialysis

facilities

• This year, experienced lower measure submissions because CMS was

able to articulate the specific types of measures we were looking for; this

reduced CMS and stakeholder review efforts

Meaningful Measures: Progress to Date

In the FY 19 Medicare Hospital IPPS and LTCH Prospective

Payment System Proposed Rule, CMS proposed:

• Eliminating a total of 19 measures (and decreasing duplication for an

additional 21 measures) that acute care hospitals are currently required to

report across the 5 hospital quality and value-based purchasing programs

• Removing 8 of the 16 CQMs to produce a smaller set of more meaningful

measures and in alignment with the Hospital IQR Program beginning with

the 2020 reporting period

• Removing certain measures that do not emphasize interoperability and the

electronic exchange of health information

• Adding new measures, such as Query of the PDMP and Verify Opioid

Treatment Agreement, related to e-prescribing of opioids

Meaningful Measures: Progress to Date

In the Quality Payment Program Year 3 NPRM, CMS proposed:

• Removing low-value and low-priority process measures

• Focusing on meaningful quality outcomes for patients

• Moving clinicians to a smaller set of Objectives and Measures with scoring

based on performance for the Promoting Interoperability performance

category

• Using the “ABC™ methodology” for public reporting on Physician

Compare, to determine benchmarks on historical data to provide clinicians

and groups with valuable information about the benchmark before data

collection starts for the performance period; the goal is to help make

measures more meaningful to patients and caregivers

Meaningful Measures: Progress to Date

MACRA Funding Opportunity to Develop Measures for Quality

Payment Program:

• Accepting applications for a new funding opportunity to develop, improve,

update, and expand quality measures for the Quality Payment Program

• Partnering directly with clinicians, patients, and other stakeholders –

through cooperative agreements – to provide up to $30 million of funding

and technical assistance in development of quality measures over 3 years

• Aligning the priority measures developed, improved, updated or expanded

under the cooperative agreements with the CMS Quality Measure

Development Plan and the Meaningful Measures framework

Meaningful Measures: Progress to Date

MACRA Funding Opportunity to Develop Measures for Quality

Payment Program (continued):

• The cooperative agreements prioritize the development of outcome

measures, including patient reported outcome and functional status

measures; patient experience measures; care coordination measures; and

measures of appropriate use of services, including measures of overuse

• The goal is for CMS to provide the necessary support to help external

organizations expand the Quality Payment Program quality measures

portfolio with a focus on clinical and patient perspectives and

minimizing burden for clinicians

Meaningful Measures: Progress to Date

MIPS Call for Measures and Activities

• Each year, CMS solicits feedback from the stakeholder community about

new measures and activities for MIPS. This year, CMS invited submissions

on:

– Quality measures for 2020

– Promoting Interoperability measures for 2020

– Improvement Activities for 2019

• CMS reviews the measure and activities submissions with the Meaningful

Measures framework in mind, focusing on those that promote better

outcomes for patients and reduced burden on clinicians.

Meaningful Measures: Progress to Date

Future of the Meaningful

Measures Initiative and Next

Steps

• Appropriate use of opioids and avoidance of harm

• Nursing home safety measures

• Interoperability and care transitions

• Appropriate use of services

• Patient-reported outcome measures

Meaningful Measure Development

• Developing more APIs for quality measure data submission

• Prototype the use of the FHIR standard for quality measurement

• Interoperable electronic registries – incentivizing use

• Harmonizing measures across registries

• Timely and actionable feedback to providers

• Working with CMMI on use of artificial intelligence to predict

outcomes

Ideal Future State for Meaningful

Measures

• Address three dimensions of implementation:

1. Conduct a thorough review of existing measures and remove those

that do not meet criteria

2. Develop meaningful measures to fill gap areas

3. Work to reduce the burden of reporting

• Continue to solicit stakeholder input to further improve the Meaningful

Measures framework

GIVE US YOUR FEEDBACK!

• MeaningfulMeasuresQA@cms.hhs.gov

Meaningful Measures Next Steps

Go to:

• https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-

Instruments/QualityInitiativesGenInfo/CMS-Quality-Strategy.html

Meaningful Measures Website

Meaningful Measures Fact Sheets

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-

Instruments/QualityInitiativesGenInfo/MMF/Shareable-Tools.html

Where to Find Meaningful Measures

CMS Measures Inventory Tool: cmit.cms.gov

Michelle Schreiber, M.D., Director of the Quality

Measurement and Value-based Incentives Group, CMS

Reena Duseja, M.D., M.S. Chief Medical Officer, Quality

Measurement and Value-Based Incentives Group, CMS

MeaningfulMeasuresQA@cms.hhs.gov

Questions